Dr. Phillips, whose background is in epidemiology and health care systems, is preparing to reenter health care research, focusing in a new area, occupational safety and health, particularly health care worker safety and bloodborne pathogens. The proposed research and related monies will facilitate this development of her career. Working with the University of Virginia School of Medicine, International Healthcare Worker Safety Center, and especially Dr. Janine Jagger, makes certain that Dr. Phillips'research will be completed in a responsible manner and that the findings will have an impact on the field. Occupational exposure to HBV, HIV and HCV remains the most life-threatening workplace risk to healthcare workers. During the last two decades, the US has led the way in primary prevention by reducing the risk of sharp injuries, the most common means of pathogen transmission. Interventions were intended to protect a high-risk population from injury while performing a routine, albeit hazardous procedure. The International Healthcare Worker Safety Center played a key role by introducing the concept of safer devices and designing and disseminating the EPINet surveillance system to document the role of device characteristics in injury causation. The first multi-hospital, multi-state research network based on EPINet was established in 1993 and includes a total of 85 hospitals. It is a national resource for documenting changing injury patterns related to the needles and sharps. The Needlestick Safety and Prevention Act of 2000 (HR 5178) was expected to change patterns of injuries during standard practice. Using the EPINet database, the proposed research will quantify injury reductions attributable to the adoption of safety-engineered devices and document the relative impact of voluntary (pre-2000) versus mandatory (post-2000) policy on the adoption of safety-engineered medical devices. Changes in injury rates will be compared to contemporaneous rates of reported blood exposures,which were not subject to legislation. Research will also compare differences in injury rates by geographic region, type of hospital, job category, department where injury occurred, and specific device. The health of practitioners, hospitals and the public will be enhanced by safer work practices, including the use of safety-engineered devices by decreasing injuries and pathogen transmission. At a more universal level, an understanding of how institutional adoption patterns are affected by voluntary and mandatory health care policies and the associated injuries and exposure outcomes will guide future compliance efforts in the U.S. and serve as a more effective global model.